Provider Demographics
NPI:1770307167
Name:ALVARADO, PERCY GRATUITO
Entity type:Individual
Prefix:
First Name:PERCY
Middle Name:GRATUITO
Last Name:ALVARADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:362 OLD GRADE RD
Mailing Address - Street 2:
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-9491
Mailing Address - Country:US
Mailing Address - Phone:843-460-7870
Mailing Address - Fax:
Practice Address - Street 1:5130 WESCOTT BLVD
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-9043
Practice Address - Country:US
Practice Address - Phone:843-486-2712
Practice Address - Fax:843-879-9808
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2610224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant